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Ohio rates for HCPCS 15771

Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.05 / $4,359.00 / $9,516.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,760.00 / $3,528.00 / $14,996.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.30 / $581.16 / $719.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.88 / $2,111.38 / $20,901.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,840.00 / $5,998.00 / $7,847.00